March 07, 2019
2 min read

Myalgia, arthralgia linked to checkpoint inhibitors vary in severity, treatment

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Cassandra Calabrese

Myalgia and arthralgia related to checkpoint-inhibitor treatment for genitourinary cancer can vary in timing, severity and treatment, and a multidisciplinary approach, including input from a rheumatologist, is critical for managing these events, according to data published in Clinical Genitourinary Cancer.

“Rheumatic [immune-related adverse events (irAEs)] remain one of the most poorly defined irAEs and we have much to learn about their incidence and prevalence clinical spectrum and optimal management,” Cassandra Calabrese, DO, of the Cleveland Clinic, told Healio Rheumatology. “While many questions remain, this study highlights the variability of rheumatic irAEs, as well as the importance of interdisciplinary care.”

To characterize the nature and treatment of myalgia and arthralgia immune-related adverse events linked to checkpoint inhibitors in patients with genitourinary cancer, Calabrese and colleagues conducted a retrospective review of individuals treated at the Cleveland Clinic Taussig Cancer Institute between January 2013 and June 2017. The researchers identified 21 patients who developed myalgia and arthralgia leading to interruption or discontinuation of checkpoint therapy, setting a follow-up cut-off date of April 2018.

Photo of cancer cell 
Myalgia and arthralgia related to checkpoint-inhibitor treatment for genitourinary cancer can vary in timing, severity and treatment, according to data.
Source: Adobe

The researchers collected and reviewed patient and disease data, as well as immune-related adverse event data. This included timing of presentation, duration, treatment and response to therapy. They then summarized the data as frequency counts and percentages.

According to the researchers, the median time from the beginning of checkpoint therapy to the presentation of myalgia and arthralgia immune-related adverse events was 5.1 months. All were treated with prednisone, with a median initial dose of 40 mg per day, for a median duration of 64 weeks. Additional treatments of either methotrexate or infliximab (Remicade, Janssen) were required in 14% of patients. Either tocilizumab (Actemra, Genentech) or gabapentin was required in 10% of patients, whereas etanercept (Enbrel, Amgen) was required in 5%.

Among the identified patients, 29% restarted checkpoint therapy after their symptoms improved, while 15% switched to a different treatment. In addition, 55% of patients demonstrated an ongoing sustained response to therapy, described as a median of 14.5 months, even with no subsequent cancer treatments.

“From this study, we learned that one quarter of our patients were unable to get off prednisone and required a steroid-sparing agent — that is not a small number,” Calabrese said. “Moving forward, we will need continued interdisciplinary collaboration between oncologists and rheumatologists for optimal patient care.” – by Jason Laday

Disclosure: Calabrese reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.